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D.M. Zapp, M.J. Mackert, A. Kampik, E.M. Messmer; In vivo Confocal Microscopy of Normal Conjunctiva and Conjunctivitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2732.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: The Rostock Cornea Modul (RCM)/Heidelberg Retinograph (HRTII) system operates with a 670 nm diode laser and therefore allows visualization of non–transparent structures in a resolution up to 1 µm. Methods: Confocal microscopy of the conjunctiva was performed in 16 healthy eyes of 12 patients aged 22–74 yrs. (ø 43 yrs.) and in 17 patients (20 eyes) with conjunctivitis using the RCM/HRTII. Conjunctival disease analyzed included acute and chronic bacterial conjunctivitis (5 patients), allergic/atopic conjunctivitis (11 patients) and cicatrizing conjunctivitis (4 patients). Between 55 and 699 images (ø 230 images) were obtained of each patient. Results: The healthy conjunctival epithelium exhibited superficial cells, wing cells and basal cells. The superficial epithelial layer often showed signs of desquamation and rare microcysts. Large round hyperreflective cells with a peripherally dislocated nucleus, most probably goblet cells, were evident throughout the epithelium. Subepithelially a highly reflective acellular structure was visible in all patients followed by a hyporeflective layer. A vascularized collagen network typically composed the conjunctival stroma. Patients with acute conjunctivitis showed a mixed inflammatory infiltrate mainly composed of neutrophils and lymphocytes in the conjunctival epithelium and stroma whereas in chronic conjunctivitis, a predominantly lymphocytic infitration was demonstrated in the epithelium, stroma and adherent to vessel walls. Papillary and follicular conjunctival reactions could be differentiated in images of the tarsal conjunctiva. In cicatrizing conjunctivitis, a mild to moderate hyperreflective subepithelial fibrosis was evident in the tarsal conjunctiva. Conclusions: In vivo confocal microscopy using the HRTII/RCM allows the visualization of conjunctival structures and permits to differentiate between different forms of conjunctivitis.
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